Manual Therapy to Treat Gluteus Medius Trigger Points

NCT02333617 | Terminated

• 1 other identifier: IRB14-00621
• Study Type: interventional
• Target: 3
• Locations: 1 country
• Sites: 1

Brief Summary

This is a blinded randomized controlled trial to assess the effectiveness of manual therapy to improve hip abduction strength in patients with acute anterior knee pain. The primary objective of this study is to see if manual therapy to the gluteus medius can significantly alter within-session measurements of hip abductor strength in patients with anterior knee pain. The secondary objective of this study is to see if manual therapy to the gluteus medius can significantly alter within session pain in patients with anterior knee pain.

Conditions

Anterior Knee Pain Syndrome; Patellofemoral Pain Syndrome

Keywords

Manual Therapy; Physical Therapy; Dry Needling; Gluteus Medius

Outcome Measures

Primary Outcomes (1)

• Change in Hip Abduction Dynamometer test

  Isometric maximal voluntary contraction strength of the hip abductor muscles will be measured with a portable dynamometer. The dynamometer is placed so as the testing pad is positioned 5cm proximal to the lateral femoral condyle. Two to three maximal voluntary contraction trials will be permitted. The subjects will be instructed to produce their maximal force without any concern for the rate of force development. The duration of these contractions will be 5 seconds, and thirty seconds of rest will be given between trials. A third trial is completed only if the difference between the first two maximal voluntary contractions is \>10%. • Hip abduction strength will be expressed as a percentage of the patient body weight.

  Baseline,Immediately Post-Intervention (anticipated at 5 minutes after baseline testing), Immediately Post-Execise (anticipated to be 1 hour after baseline testing)

Secondary Outcomes (1)

• Change in Numeric Pain Rating Scale (NPRS) during single leg squat

  Baseline,Immediately Post-Intervention (anticipated at 5 minutes after baseline testing), Immediately Post-Execise (anticipated to be 1 hour after baseline testing)

Study Arms (3)

Dry Needling and Exercise

EXPERIMENTAL

Dry Needling to treat gluteus medius trigger points followed by hip and core exercises.

Other: Dry Needling; Other: Hip and core strengthening exercises

Soft Tissue Mobilization

ACTIVE COMPARATOR

Soft tissue mobilization to treat gluteus medius trigger points followed by hip and core exercises.

Other: Soft Tissue Mobilization; Other: Hip and core strengthening exercises

Placebo Control

PLACEBO COMPARATOR

Placebo to control for hands on time and attention from therapist followed by hip and core exercises.

Other: Placebo Control; Other: Hip and core strengthening exercises

Interventions

Dry Needling OTHER

Dry Needling will be performed on the patient's ipsilateral gluteus medius muscle with the patient in sidelying. The treating therapist will use the appropriate needle based upon patient's size and location of trigger point \[No. 5 (0.25 x 40mm), No. 8 (0.30 x 50mm), or No. 11 (0.30 x 75mm)\]. They will target trigger points identified in the ipsilateral gluteus medius. Once the needling is inserted into the trigger point the needle will be moved in multiple directions until the first local twitch response is noted. Once the first local twitch response is obtained, the needling will be performed in an up-and-down fashion, performing 2- to 3-mm vertical motions with no rotations (fast-in and fast-out technique), at approximately 1 Hz for 25 to 30 seconds, with the aim of eliciting local twitch responses. The treating therapist can dry needle each trigger point identified in the gluteus medius with a maximum treatment time of 5 minutes.

Dry Needling and Exercise

Soft Tissue Mobilization OTHER

Soft tissue mobilization will be performed on the patient's ipsilateral gluteus medius muscle with the patient in sidelying. The treating therapist will apply firm pressure with the palm and side of their hand. The treating therapist will mobilize the gluteus medius muscle in 4 separate directions (Proximal-Distal, Distal-Proximal, Medial-Lateral, and Lateral-Medial). The treating therapist will apply the pressure to reach the upper limit of the patient's tolerable discomfort. At any point in time the patient can request for the therapist to decrease the pressure applied. The treating therapist will perform soft tissue mobilization for 20 mobilizing strokes in each of the 4 directions.

Soft Tissue Mobilization

Placebo Control OTHER

Treating therapist will place hands on the patient's gluteus medius muscle and gently rub, but not apply enough pressure to treat the muscles trigger point. This placebo control is designed to account for hands on time from therapist in the 2 other treatment groups, as well as blinding patient to treatment group.

Placebo Control

Hip and core strengthening exercises OTHER

Patient will perform standardized hip and core exercises using body weight, and elastic bands for resistance. Exercises will take approximately 40 minutes to complete.

Dry Needling and Exercise; Placebo Control; Soft Tissue Mobilization

Eligibility Criteria

• Age: 13 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Acute anterior knee pain of \<90days
• Ipsilateral hip abductor weakness of \>15%
• /10 pain with single leg squat

You may not qualify if:

• Contraindication to dry needling or soft tissue mobilization
• Non-mechanical anterior knee pain
• Fear of needles

Sponsors & Collaborators

• Mitchell Selhorst: lead

Study Sites (1)

Nationwide Children's Hospital Sports and Ortho PT East Broad

Columbus, Ohio, 43213, United States

Location

Related Publications (14)

• Ireland ML, Willson JD, Ballantyne BT, Davis IM. Hip strength in females with and without patellofemoral pain. J Orthop Sports Phys Ther. 2003 Nov;33(11):671-6. doi: 10.2519/jospt.2003.33.11.671.

  PMID: 14669962 BACKGROUND

• McCurdy K, Walker J, Armstrong R, Langford G. Relationship between selected measures of strength and hip and knee excursion during unilateral and bilateral landings in women. J Strength Cond Res. 2014 Sep;28(9):2429-36. doi: 10.1519/JSC.0000000000000583.

  PMID: 24942172 BACKGROUND

• Munro A, Herrington L, Carolan M. Reliability of 2-dimensional video assessment of frontal-plane dynamic knee valgus during common athletic screening tasks. J Sport Rehabil. 2012 Feb;21(1):7-11. doi: 10.1123/jsr.21.1.7. Epub 2011 Nov 15.

  PMID: 22104115 BACKGROUND

• Hua NK, Van der Does E. The occurrence and inter-rater reliability of myofascial trigger points in the quadratus lumborum and gluteus medius: a prospective study in non-specific low back pain patients and controls in general practice. Pain. 1994 Sep;58(3):317-323. doi: 10.1016/0304-3959(94)90125-2.

  PMID: 7838580 BACKGROUND

• Prins MR, van der Wurff P. Females with patellofemoral pain syndrome have weak hip muscles: a systematic review. Aust J Physiother. 2009;55(1):9-15. doi: 10.1016/s0004-9514(09)70055-8.

  PMID: 19226237 BACKGROUND

• Roach S, Sorenson E, Headley B, San Juan JG. Prevalence of myofascial trigger points in the hip in patellofemoral pain. Arch Phys Med Rehabil. 2013 Mar;94(3):522-6. doi: 10.1016/j.apmr.2012.10.022. Epub 2012 Nov 2.

  PMID: 23127304 BACKGROUND

• Schmidt J, Iverson J, Brown S, Thompson PA. Comparative reliability of the make and break tests for hip abduction assessment. Physiother Theory Pract. 2013 Nov;29(8):648-57. doi: 10.3109/09593985.2013.782518. Epub 2013 May 24.

  PMID: 23706084 BACKGROUND

• Stickler L, Finley M, Gulgin H. Relationship between hip and core strength and frontal plane alignment during a single leg squat. Phys Ther Sport. 2015 Feb;16(1):66-71. doi: 10.1016/j.ptsp.2014.05.002. Epub 2014 Jun 3.

  PMID: 25070759 BACKGROUND

• Thorborg K, Petersen J, Magnusson SP, Holmich P. Clinical assessment of hip strength using a hand-held dynamometer is reliable. Scand J Med Sci Sports. 2010 Jun;20(3):493-501. doi: 10.1111/j.1600-0838.2009.00958.x. Epub 2009 Jun 23.

  PMID: 19558384 BACKGROUND

• Widler KS, Glatthorn JF, Bizzini M, Impellizzeri FM, Munzinger U, Leunig M, Maffiuletti NA. Assessment of hip abductor muscle strength. A validity and reliability study. J Bone Joint Surg Am. 2009 Nov;91(11):2666-72. doi: 10.2106/JBJS.H.01119.

  PMID: 19884441 BACKGROUND

• Beenakker EA, van der Hoeven JH, Fock JM, Maurits NM. Reference values of maximum isometric muscle force obtained in 270 children aged 4-16 years by hand-held dynamometry. Neuromuscul Disord. 2001 Jul;11(5):441-6. doi: 10.1016/s0960-8966(01)00193-6.

  PMID: 11404114 BACKGROUND

• Bohannon RW. Reference values for extremity muscle strength obtained by hand-held dynamometry from adults aged 20 to 79 years. Arch Phys Med Rehabil. 1997 Jan;78(1):26-32. doi: 10.1016/s0003-9993(97)90005-8.

  PMID: 9014953 BACKGROUND

• Crossley KM, Zhang WJ, Schache AG, Bryant A, Cowan SM. Performance on the single-leg squat task indicates hip abductor muscle function. Am J Sports Med. 2011 Apr;39(4):866-73. doi: 10.1177/0363546510395456. Epub 2011 Feb 18.

  PMID: 21335344 BACKGROUND

• Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine (Phila Pa 1976). 2005 Jun 1;30(11):1331-4. doi: 10.1097/01.brs.0000164099.92112.29.

  PMID: 15928561 BACKGROUND

MeSH Terms

Conditions

Patellofemoral Pain Syndrome

Interventions

Dry Needling; Papaverine

Condition Hierarchy (Ancestors)

Joint Diseases; Musculoskeletal Diseases

Intervention Hierarchy (Ancestors)

Complementary Therapies; Therapeutics; Physical Therapy Modalities; Benzylisoquinolines; Alkaloids; Heterocyclic Compounds; Opiate Alkaloids; Isoquinolines; Heterocyclic Compounds, 2-Ring; Heterocyclic Compounds, Fused-Ring

Study Officials

• Mitchell Selhorst, DPT

  Nationwide Childrens Hospital

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: December 23, 2014
• First Posted: January 7, 2015
• Study Start: January 1, 2015
• Primary Completion: December 1, 2017
• Study Completion: December 1, 2017
• Last Updated: January 24, 2018

Record last verified: 2018-01

Locations

US (1)